Provider Demographics
NPI:1467133876
Name:PALOMINO LAZA, ELEANET
Entity Type:Individual
Prefix:
First Name:ELEANET
Middle Name:
Last Name:PALOMINO LAZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 PRINCETON LAKES DR APT 210
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-2008
Mailing Address - Country:US
Mailing Address - Phone:813-340-4579
Mailing Address - Fax:
Practice Address - Street 1:1413 TECH BLVD STE 112
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7822
Practice Address - Country:US
Practice Address - Phone:813-305-2867
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst